IDA(缺铁性贫血)

Megaloblastic Anemia
Defination:
• Nutritional VitB12 or folic acid deficiency anemia was defined as the deficiency in either VitB12 or Folic acid.
• In India, 6.8% children had folate deficiency, 32% showed vinB12 deficiency and combined deficiency • China--rare
3 stages
• Iron depletion, ID: • Iron deficient erythropoiesis, IDE • Iron deficiency anemia, IDA
Impact on body health by ID
• 1. Hematopoieticsystem: gradual anemia Stages Ferritin Serum iron, SI ID Low N IDE L L IDA L L
• In 2015 anemia due to iron deficiency resulted in about 54,000 deaths – down from 213,000 deaths in 1990.
Disability-adjusted life year for irondeficiency anemia per 100,000 inhabitants in 2004.
Clincal Manifestations
Metabolism of Iron
A. Iron distribution in the body
A. Iron distribution in the body
B. The source of iron
• Endogenous old RBC (2/3) • Exogenous
through food (1/10mg/d)
Hb N N L
Impact on body health by ID (continued)
• 2. GI system: absorptive disorders; • 3. Circulative system: cardiac contractivity decrease, heart enlargement, murmur and heart failure; • 4. Neuroschycological system: insomnia, attention absent (aprosexia), apathy; • 5. Immune system: compromised immunity, susceptible to infection; • 6. Skin and hair system: dryness of skin, sparse and brittle hairs,loss of polish, fragile nails, koilonychia;
Diagnosis and differential diagnosis
• Diagnosis: History clinical manifestation lab tests • Differential diagnosis:(Hypochromic and microcytic anemias) •thalassemia, •lead poisoning, •chronic infection etc.
• 1. Insufficient iron store: premature, severe maternal iron deficiency, intrauterus transfusion etc. • 2. Insufficient intake: food with insufficient iron, e.g. fed with milk, flour or rice flour only etc. • 3. Absorptive problems: chronic diarrhea, steatorrhea • 4. Growth demand: young infants, premature baby, adolescent children, girls after menarche etc. • 5. Blood loss: chronic gastrointestinal bleeding caused by peptic ulcer, hook worm, multiple polyps, angioma, diverticuloritis or inflammative enteropathy, or acute blood loss with injury or epitaxisetc.
Lab tests--Blood smear:
Microcytic and hypochromic RBC
BM smear：
• Cellularity: hypercellularity; • Iron stain: compromised both intercellular and intracellular iron stains.
• 1、IDA: is a gradual process which can be divided into 3 stages, ie, ID stage, IDE stage and IDA stage. • 2、Ferritin is the most sensitive marker for IDA; • 3、Once Hbhas been recovered to normal level, iron agents should be used continuesllyfor another 2 months.
Metabolism of VitB12 and Folic acid
Folic acid: Food: rich in green vegetible, lack in sheep milk; Absorptive site: at upper portion of jejunum;
Vitamin B12: Food: rich in animal food; Absorptive site: terminus of ileum; Absorption helping factor: internal factor.
• Developing nucleated erythrocytes: delayed cytoplasmicdevelopment;
Indices of iron nutrition
• SI (serum iron) • Fn (Ferritin) • TIBC (total iron ing capacity) • FEP (free erythrocyticprotopophrin)
C. Physiological requirement of iron:
• 1mg ～1.5mg/kg/d (<15yr) • Premature 2mg/kg/d
Index of iron nutrition
TIBC and iron saturation in IDA
Etiology of iron deficiency
Animal foods with high iron content and high heme iron, the absorption rate of 10-25%
Iron of vegetable food is non-heme iron, the absorption rate of 1.7-7.9%
Blood Transfusion
• when it is necessary. 1. severe anemia with congestive cardiac failure 2. with severe infection 3. need surgery Hb <60g/L, red cell transfusion , 4-6ml/kg HB>60g/L, NO.
Etiology
Decreased intake （vegetarian--VB12, goat milk—Folic acid ); Increasing demands; Impaired absorption (celiac disease, intestinal parasites) Disease impacts; Congenital defects: 1、congenital FA absorptive defects; 2、Juvenile pernicious anemia; 3、congenital transcobalamin defects。
Iron Deficiency Anemia (IDA)
Dr. Liu Chonghai
• Iron-deficiency anemia affected about 1.48 billion people in 2015. • A lack of dietary iron is estimated to cause approximately half of all anemia cases globally. • Women and young children are most commonly affected.
Clinical Manifestation
• Age:6 months ~ 3yrs • General: anemic pale, positional hypotension; • GI system: diarrhea, dyspepsia, nausea, vomiting • Hematopoietic System: hepatosplenomegaly (extramedullary hematopoiesis) • Circulatory system: tachycardia, murmurs and heart enlargement; • Immune system: infection; • Neuropsycological system: pica, apathy;